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Psych🆘 > 3 Stressor/ Anxiety > Flashcards

3 Stressor/ Anxiety Flashcards

1
Q

What are anxiety disorders?

A

Anxiety disorders are characterized by excessive or inappropriate fear or anxiety.

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2
Q

What is fear?

A

Fear is a transient increase in sympathetic activity due to a perceived threat.

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3
Q

What is anxiety?

A

Anxiety is apprehension regarding the possibility of a negative future event.

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4
Q

What symptoms must anxiety disorders cause?

A

Symptoms must cause clinically significant distress or impairment in social or occupational functioning.

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5
Q

What are the major anxiety disorders in DSM-5?

A

Generalized Anxiety Disorder (GAD), Panic Disorder, Agoraphobia, Social Anxiety Disorder (Social Phobia), Selective Mutism, Specific Phobias.

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6
Q

What causes anxiety disorders?

A

• Genetic factors
• Biological factors (Neurotransmitters: norepinephrine (NE), serotonin (5-HT), gamma-aminobutyric acid (GABA))
• Environmental factors
• Psychosocial factors

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7
Q

How do you diagnose primary anxiety disorders?

A

• Rule out symptoms caused by:
• Substance use or withdrawal (e.g., alcohol, caffeine, stimulants).
• Medications (see Table 5-2).
• Medical conditions (see Table 5-3).

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8
Q

What are common physical symptoms of anxiety?

A

• Constitutional: Fatigue, diaphoresis, shivering
• Cardiac: Chest pain, palpitations, tachycardia, hypertension
• Pulmonary: Shortness of breath, hyperventilation
• Neurologic/Musculoskeletal: Vertigo, light-headedness, tremors, insomnia, muscle tension
• Gastrointestinal: Nausea, abdominal discomfort, diarrhea, constipation

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9
Q

What medications and substances can cause anxiety?

A

• Intoxication: Alcohol, cannabis, hallucinogens (LSD, PCP, MDMA), stimulants (amphetamines, cocaine), caffeine, tobacco
• Withdrawal: Alcohol, sedatives, opioids, stimulants, caffeine, tobacco

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10
Q

What medical conditions can cause anxiety?

A

• Neurologic: Epilepsy, migraines, brain tumors, multiple sclerosis, Huntington’s disease
• Endocrine: Hyperthyroidism, hypoglycemia, pheochromocytoma, carcinoid syndrome
• Metabolic: Vitamin B12 deficiency, electrolyte abnormalities, porphyria
• Respiratory: Asthma, COPD, hypoxia, pulmonary embolism, pneumonia, pneumothorax
• Cardiovascular: Congestive heart failure, angina, arrhythmia, myocardial infarction

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11
Q

How is anxiety treated?

A

Mild anxiety: Psychotherapy. Moderate to severe anxiety: Combination of psychotherapy and pharmacotherapy.

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12
Q

What are the first-line medications for anxiety disorders?

A

• Selective serotonin reuptake inhibitors (SSRIs): e.g., sertraline
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): e.g., venlafaxine

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13
Q

Can benzodiazepines be used for anxiety?

A

Yes, but only for short-term use. Avoid in patients with substance use disorders due to risk of dependence.

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14
Q

What are alternative medications for anxiety disorders?

A

• Buspirone: A non-benzodiazepine anxiolytic
• Beta-blockers (e.g., propranolol): Used for performance anxiety
• Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs): Used if first-line treatments fail

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15
Q

What are effective psychotherapy options for anxiety disorders?

A

• CBT (Cognitive-Behavioral Therapy): Most effective
• Psychodynamic psychotherapy: Helps identify unconscious anxiety causes

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16
Q

What is a panic attack?

A

A sudden onset of intense fear or anxiety, peaking within minutes and resolving within 30 minutes.

• Can be triggered or spontaneous.

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17
Q

What are the symptoms of a panic attack?

A

Mnemonic: Da PANICS

• Dizziness, Derealization, Depersonalization
• Palpitations, Paresthesias
• Abdominal distress
• Numbness, Nausea
• Intense fear of dying, losing control
• Chills, Chest pain
• Sweating, Shaking, Shortness of breath

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18
Q

What is Panic Disorder?

A

• Recurrent, unexpected panic attacks
• At least 1 month of:
• Worry about future attacks
• Maladaptive behavior to avoid attacks

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19
Q

What are risk factors for Panic Disorder?

A

• Genetic predisposition
• Psychosocial stressors (e.g., childhood trauma)

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20
Q

What are the first-line treatments for Panic Disorder?

A

CBT + SSRIs or SNRIs, benzodiazepines as bridge therapy.

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21
Q

What is Agoraphobia?

A

Fear of public places where escape is difficult, may develop after panic attacks.

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22
Q

What are the diagnostic criteria for Agoraphobia?

A

Intense fear/anxiety about at least two situations like being outside alone or in crowds.

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23
Q

How is Agoraphobia treated?

A

CBT + SSRIs.

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24
Q

What are Specific Phobias?

A

Irrational fears of specific objects or situations.

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25
What are the common types of Specific Phobias?
Animal, natural environment, situational, blood-injection-injury.
26
How is a Specific Phobia diagnosed?
Fear is persistent, avoidance or extreme distress, out of proportion to actual danger.
27
What is the most effective treatment for Specific Phobias?
CBT with Exposure Therapy.
28
What is Social Anxiety Disorder?
Fear of social scrutiny, embarrassment, or rejection.
29
What are common social situations that cause anxiety?
Public speaking, eating in public, using public restrooms.
30
How is Social Anxiety Disorder treated?
CBT (first-line), SSRIs or SNRIs if severe.
31
What is Selective Mutism?
A rare disorder where a child does not speak in specific situations despite normal speech ability.
32
What are the diagnostic criteria for Selective Mutism?
Consistent failure to speak in specific social settings, symptoms last at least 1 month.
33
How is Selective Mutism treated?
CBT, family therapy, SSRIs if comorbid with Social Anxiety Disorder.
34
What is Separation Anxiety Disorder?
Excessive fear of separation from attachment figures that is developmentally inappropriate.
35
What are the diagnostic criteria for Separation Anxiety Disorder?
≥3 symptoms like extreme distress when separated, excessive worry about attachment figures.
36
How is Separation Anxiety Disorder treated?
CBT, family therapy, SSRIs if severe.
37
What is Generalized Anxiety Disorder (GAD)?
• Excessive, persistent worry about multiple aspects of life (e.g., work, health, finances) for ≥6 months. • Associated with physical symptoms such as fatigue, muscle tension, restlessness, and sleep disturbance.
38
What are the diagnostic criteria for GAD?
6 WCRIIFCM • Excessive anxiety/worry for ≥6 months. • Difficult to control worry. • ≥3 of the following symptoms: 1. Restlessness 2. Fatigue 3. Impaired concentration 4. Irritability 5. Muscle tension 6. Insomnia • Not due to another medical condition or substance use. • Causes significant impairment in daily functioning.
39
How common is GAD?
• Lifetime prevalence: 5–9%. • More common in women (2:1 ratio). • Highly comorbid with other anxiety and depressive disorders.
40
How is GAD treated?
• First-line treatment: CBT + SSRIs (e.g., sertraline, escitalopram) or SNRIs (e.g., venlafaxine, duloxetine). • Alternative options: • Short-term benzodiazepines for acute symptoms. • Buspirone (not effective as monotherapy). • TCAs or MAOIs (if other treatments fail).
41
What is Obsessive-Compulsive Disorder (OCD)?
• A disorder involving obsessions and/or compulsions that cause significant distress and impairment.
42
What are obsessions in OCD?
• Intrusive, anxiety-provoking thoughts, images, or urges that the patient tries to suppress.
43
What are compulsions in OCD?
• Repetitive behaviors or mental acts performed in response to an obsession to reduce anxiety.
44
What are the diagnostic criteria for OCD?
• Presence of obsessions and/or compulsions. • Time-consuming (≥1 hour/day) and cause distress or dysfunction. • Not due to another medical or mental disorder.
45
What are common OCD symptom patterns?
• Contamination fears → excessive handwashing. • Doubt (e.g., doors unlocked) → repeated checking. • Need for symmetry → arranging objects. • Intrusive taboo thoughts → mental rituals.
46
How is OCD treated?
• First-line: CBT (Exposure and Response Prevention) + SSRIs (e.g., fluoxetine, sertraline). • Second-line: SNRIs or clomipramine (a TCA with strong serotonin selectivity). • Severe/refractory cases: Augment with atypical antipsychotics or consider psychosurgery (cingulotomy) or ECT.
47
What is Body Dysmorphic Disorder?
• Preoccupation with nonexistent or minor physical defects that cause distress and impair social/occupational functioning.
48
What are the diagnostic criteria for Body Dysmorphic Disorder?
• Preoccupation with a perceived physical defect. • Repetitive behaviors (e.g., mirror-checking, excessive grooming) or mental acts (e.g., comparing to others). • Not better accounted for by an eating disorder.
49
How is Body Dysmorphic Disorder treated?
First-line: CBT SSRIs if severe.
50
What is Hoarding Disorder?
• Persistent difficulty discarding possessions, regardless of value. • Results in excessive clutter that compromises living space.
51
What are the diagnostic criteria for Hoarding Disorder?
• Difficulty discarding possessions. • Accumulation that clutters living spaces. • Significant distress or impairment.
52
How is Hoarding Disorder treated?
• CBT (most effective). • SSRIs (less effective than for OCD).
53
What is Trichotillomania?
• Recurrent hair pulling leading to hair loss. • Repeated attempts to stop.
54
How is Trichotillomania treated?
• Habit Reversal Training (CBT). • SSRIs, atypical antipsychotics, or N-acetylcysteine.
55
What is Excoriation Disorder?
• Recurrent skin-picking resulting in lesions.
56
How is Excoriation Disorder treated?
• CBT (Habit Reversal Training). • SSRIs (if severe).
57
What is PTSD?
• PTSD is a disorder that develops after exposure to actual or threatened death, serious injury, or sexual violence, leading to multiple symptoms including: • Intrusive symptoms (e.g., nightmares, flashbacks, distressing memories). • Avoidance of trauma-related stimuli. • Negative alterations in thoughts and mood. • Increased arousal and reactivity (e.g., hypervigilance, exaggerated startle response).
58
How does PTSD differ from Acute Stress Disorder?
| Trauma can occur at any time in the past. | Trauma occurred <1 month ago. | | Symptoms last >1 month. | Symptoms last <1 month. |
59
What are the diagnostic criteria for PTSD?
• Exposure to trauma (directly experiencing, witnessing, learning about a loved one’s trauma, or repeated exposure to traumatic details). • Recurrent intrusive symptoms (e.g., nightmares, flashbacks, distress at trauma cues). • Active avoidance of distressing trauma-related stimuli (e.g., memories, people, places). • ≥2 Negative alterations in cognition/mood (e.g., dissociative amnesia, self-blame, negative emotions, detachment). • ≥2 Symptoms of increased arousal/reactivity (e.g., hypervigilance, exaggerated startle response, irritability, insomnia). • Symptoms cause significant impairment in social or occupational functioning. • Not due to substance use or another medical condition.
60
What are the risk factors for developing PTSD?
• Female gender (higher risk due to increased exposure to interpersonal violence). • Exposure to prior trauma, especially in childhood. • Genetic predisposition.
61
What is the course of PTSD?
• Symptoms usually begin within 3 months of trauma, but may be delayed. • 50% of patients recover within 3 months, but symptoms may persist in others. • 80% of patients with PTSD have a comorbid mental disorder (e.g., depression, anxiety, substance use disorder).
62
What are the treatments for PTSD?
• First-line pharmacotherapy: • SSRIs (sertraline, fluoxetine) or SNRIs (venlafaxine). • Prazosin (α1-receptor antagonist) can be used for PTSD-related nightmares and hypervigilance. • Atypical antipsychotics may be considered in severe, treatment-resistant cases. • First-line psychotherapy: • Cognitive-Behavioral Therapy (CBT) (e.g., exposure therapy, cognitive processing therapy). • Supportive and psychodynamic therapy. • Couples/family therapy.
63
What is Adjustment Disorder?
• Emotional or behavioral symptoms in response to a non-life-threatening stressful life event (e.g., divorce, job loss). • Symptoms cause distress that is out of proportion to the stressor.
64
What are the diagnostic criteria for Adjustment Disorder?
• Symptoms develop within 3 months of a stressor. • Symptoms cause significant distress or impairment. • Not due to another mental disorder. • Symptoms resolve within 6 months after the stressor has ended.
65
What are the subtypes of Adjustment Disorder?
• With depressed mood • With anxiety • With mixed anxiety and depressed mood • With disturbance of conduct (e.g., aggression) • With mixed emotional and behavioral symptoms
66
What is the treatment for Adjustment Disorder?
• Supportive psychotherapy (first-line). • Group therapy. • Pharmacotherapy for symptom relief (e.g., SSRIs for anxiety, sleep aids for insomnia).
67
What are the key differences between PTSD and Adjustment Disorder?
| PTSD | Adjustment Disorder | | — | — | | Life-threatening trauma is the stressor. | Non-life-threatening stressor. | | Symptoms last >1 month. | Symptoms last <6 months after the stressor ends. | | Includes flashbacks, hypervigilance, and intrusive thoughts. | No flashbacks or hypervigilance. |
68
What mnemonic helps remember PTSD symptoms?
• TRAUMA • Traumatic event • Re-experiencing • Avoidance • Unable to function • Month or more of symptoms • Arousal increased
69
What medication is used to treat PTSD nightmares?
Prazosin (α1-receptor antagonist).
70
What is the first-line treatment for most anxiety disorders?
CBT + SSRIs.
71
How long should treatment for anxiety disorders continue?
At least 6 months before attempting to taper medications.

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